This week, the editors of the British Medical Journal, Nursing Times and Health Service Journal took the unprecedented step of publishing a joint editorial lambasting the government's health proposals as an "unholy mess". They join a long and distinguished list of critics who, even at this late stage, think the health and social care bill is not fit for purpose.

Since the white paper was published in July 2010 and the health and social care bill was issued in January 2011, the coalition has fought a weary but ultimately unsuccessful campaign to persuade the public, media, health professionals and even many of its own supporters of the merits of the proposed changes. But the longer people have had to consider them, the less they seem to like them. Important stakeholders like the British Medical Association and the Royal College of Nursing, the medical Royal Colleges, the NHS Confederation, the health select committee, and thinktanks such as the King's Fund faintly praised the changes in principle at first, while raising concerns about their implementation in practice. But even though the government has given some ground with amendments to the legislation being introduced, most stakeholders have now gradually moved to oppose the changes.

This 460-page, convoluted piece of legislation was never really needed to achieve the government's stated policy intentions – increasing GP involvement in commissioning, creating more patient choice, promoting competition and diversity of supply in healthcare provision. It is an ambitious legislative folly, born of startling political naivety and weak internal scrutiny. It is a massive legislative experiment with markets, competition and regulation, all of which would affect a public service that the public are largely satisfied with and hold dear.

If the bill does become law, then the government's troubles really begin. It faces the political realities of implementing its new market-driven regime of healthcare funding and provision in which corporate and private interests will take precedence over local communities' concerns. There are many healthcare systems up and down the country where the same scenario will be played out: for-profit companies will cherry-pick parts of healthcare provision to bid for, leaving the unprofitable or difficult services to NHS trusts, which will in turn be pushed into deficit and result in service cuts. Rightly or wrongly, every service reconfiguration, hospital closure or quality scandal will also be blamed on the government's NHS shakeup.

It would make political, financial and organisational sense for the government to abandon the bill, despite the loss of face that would entail. But to do so, the coalition government would need a plan B, and it might look something like this: first, the government could argue that it has already dramatically slimmed down the NHS bureaucracy it inherited from Labour and made most of the savings it promised. Rather than inventing a new one to take its place (the proposed NHS commissioning board would be one of the largest quangos ever with running costs of £492m a year and over 3,700 staff; the 260-plus clinical commissioning groups would cost about £1.25bn a year to run) it will simply make the transitional structures it has put in place to run the NHS permanent. No more reorganisation, and no more spending on setting up new statutory bodies.

Second, the government could make it clear that, just as the health select committee has been saying for over a year, the really big challenge for the NHS is to get far greater efficiency out of current spending. That means not just running existing services more efficiently, but embarking on a comprehensive redesign of local healthcare systems to promote greater integration and less duplication. In some places, it would imply having to make difficult decisions about the viability of smaller hospitals and the services they provide. Dropping the bill would allow NHS organisations to give their undivided attention to the Nicholson challenge and truly focus on efficiency savings.

Third, it could argue that the Mid Staffordshire public inquiry is going to report this summer, and its recommendations will be so fundamental to the future organisation of the NHS that it makes sense to stop the bill and introduce new legislation after the inquiry report is published.

Fourth, it could argue – as it has already started to – that there needs to be a new and overriding focus in the NHS on the quality of care, and especially to ensuring the consistent delivery of basic standards in nursing, especially to elderly and vulnerable patients. The public are likely to be more interested in reforms that put nurses and doctors back into clinical practice, cut their administrative workload and ensure that care standards are rigorously and routinely monitored.

The new political narrative would be one of lean management, improved efficiency and a relentless focus on clinical quality. At the same time, existing legislative provisions could be used to pursue markets, competition and diversity of provision, but without a "big bang" approach and the huge political risks it entails.

This has been a bruising education for the coalition. They are now paying for their failure to establish from the outset a clear narrative explaining what the problems were and how the changes would make things better; and to get doctors and nurses on their side. It remains to be seen whether they have the bravery to change course, or will just grimly hang on and hope that if they can force the bill through parliament, things will get better for them.